What is DOT?

DOT means that a trained health care worker or other designated
individual (excluding a family member) provides the prescribed TB drugs
and watches the patient swallow every dose.

Why use DOT?

We cannot predict who will take medications as directed, and who
will not. People from all social classes, educational backgrounds, ages,
genders, and ethnicities can have problems taking medications correctly.

Studies show that 86-90% of patients receiving DOT complete therapy,
compared to 61% for those on self-administered therapy.

DOT decreases the risk of drug-resistance resulting from erratic
or incomplete treatment.

DOT decreases the chances of treatment failure and relapse.

Who can deliver DOT?

A nurse or supervised outreach worker from the patient’s county
public health department normally provides DOT.

In some situations, it works best for clinics, home care agencies,
correctional facilities, treatment centers, schools, employers, and
other facilities to provide DOT, under the guidance of the local health
department.

Family members should not be used for DOT. DOT providers must remain
objective.

For complex regimens including IV/IM medications or twice daily dosing,
home care agencies may provide DOT or share responsibilities with the
local health department.

If resources for providing DOT are limited, priority should be given
to patients most at risk. See the MDH
DOT Risk Assessment form for help identifying high-priority patients.

How is DOT administered?

DOT includes:

delivering the prescribed medication

checking for side effects

watching the patient swallow the medication

documenting the visit

answering questions

DOT should be initiated when TB treatment starts. Do not allow the
patient to try self-administering medications and missing doses before
providing DOT. If the patient views DOT as a punitive measure, there
is less chance of successfully completing therapy.

The prescribing physician should show support for DOT by explaining
to the patient that DOT is widely used and very effective. The DOT provider
should reinforce this message.

DOT works best when used with a patient-centered case management
approach, including such things as:

helping patients keep medical appointments

providing ongoing patient education

offering incentives and/or enablers

connecting patients with social services or transportation

Patients taking daily therapy can usually self-administer their weekend
doses.